Second opinion: Talking detox with Gwyneth Paltrow’s doctor

The complexities of evidence in the context of alternative medicine

by Julia Belluz

Alejandro Junger is a “cleanse specialist,” a detox evangelist and a celebrity healer. These days he’s best known as Gwyneth Paltrow’s doctor, the medical expert behind her new diet and cookbook.

When Science-ish received an invitation to speak with Dr. Junger, we accepted. It seemed as good a time as any to explore the complexities of evidence in the context of alternative medicine.

Paltrow’s new cookbook It’s All Good is based on Dr. Junger’s “elimination diet,” which involved abstaining from many foods—wheat, meat, potatoes, sugar, dairy, eggs, even some vegetables—to restore her health after a year of stress and french fries.

Dr. Junger has advised Paltrow and other celebrities on alternative therapies. Now, he offers a range of cleanses on his website, treatments many “mainstream doctors”—if you call them that—would say are woo-based at best and malpractice at worst.

In the spirit of scientific inquiry, Science-ish called Dr. Junger.

The doctor was fresh off an appearance on the Dr. Oz Show, which for skeptical readers might sound alarm bells. We talked about the science that underpins his work. “The best evidence is the results that I see with patients,” said the U.S. board-certified physician in internal medicine and cardiology.

He talked of turning around the lives of frayed and frail patients. In scientific language he described tests that identify “toxic triggers,” the things that might “damage” someone’s guts.

He offered a moving anecdote about a childhood friend from Uruguay, where he grew up. The friend’s wife was diagnosed with Behçet’s syndrome, an inflammation of blood vessels that can lead to chronic pain, blindness and sores in the mucosa-lining of the mouth and sex organs. Doctors put her on chemotherapy and the steroid prednisone, but she couldn’t get better.

Then she met Dr. Junger.

Without running a test he knew she had a “leaky gut.” He said he prescribed medications to get rid of her yeast overgrowth and parasites, plus probiotics and a “gut-program diet.” In two weeks, 95 per cent of her symptoms vanished. “She felt better than she had ever felt!” said Dr. Junger. “No chemotherapy. No prednisone. Not even an aspirin.”

(The new science of the gut is very promising, but it’s early days. As well, there’s no good science behind a recreational “detox” unless it’s in the context of an overdose or occupational hazard.)

Dr. Junger says he wishes more doctors would explore “open-minded medicine,” including alternative treatments and lifestyle approaches. “I want people to learn not to take the prescription pad out and write one for prednisone and chemotherapy that fast.”

Who hasn’t been defeated by the limits of medicine or a doctor’s eagerness to prescribe pills? Who doesn’t want to transform their life and feel their absolute best? Who would say no to a quick fix — especially one you can buy online for $425?

Near the end of our call, Dr. Junger extended an invite to L.A.  “Spend a few days,” he said. “I’ll get you cured of the evidence-based medicine disease.”

Before hopping a plane, Science-ish wanted to explore some of Dr. Junger’s claims.

The doctor points to success stories to defend his practice. When asked if he systematically studies patients and compares them to a control group, to explore if results are real and long-term, one of Dr. Junger’s colleagues explained that such an approach would take years. “We are not a hospital or research institute or funded by the NIH (National Institutes of Health),” the colleague added in a later email. “We don’t have the resources, nor is it our focus.”*

But evidence-based medicine doesn’t work that way. Decisions are drawn from science and rooted in the best-available research. When therapies are new, practitioners proceed with caution. Even when the placebo effect might offer relief to a desperate patient, an evidence-based doctor considers potential harms and falls back on the science.

Or he undertakes careful study to get better research. Take Dr. Stephen Sagar, a McMaster University oncologist who started to explore alternative medicine in the mid-1990s. Patients were arriving in his clinic on myriad therapies to “cure cancer,” from unregulated drugs, to herbs, supplements and special diets. At the time, there was little research on how such treatments affected cancer patients. Dr. Sagar’s research in Hamilton and with teams of U.S. academics was not promising. “We found many of these interventions have been shown to have no benefit.” (Dr. Sagar contacted Science-ish after this piece was published to note that some randomized trials have found that a small number of alternative treatments alleviate symptoms related to cancer, such as acupuncture for pain.)

Even still, he meets patients experimenting with various forms of alternative medicine—treatments suggested by “grandmothers, hairdressers, some kind of urban myth or one person they know who got cured.”

When evidence is emerging or unclear,  Dr. Victor Montori starts with the first principle of the Hippocratic Oath: do no harm. “There’s a risk-benefit balance, and in the absence of knowledge,” says the professor of medicine at the Mayo Clinic, “I take a conservative attitude, stay away from the stuff that’s new, that’s untested.”

In his decades on the job, he has watched the evolution of science expose the dangers of touted treatments from diabetes drugs to supplements.  “Advocacy shouldn’t be for the widespread adoption of natural or alternative medicine products,” he said, “but for testing.”

Amazing cures and dramatic treatment effects don’t come around too often. (See Chapter 5 of Testing Treatments.) Knowledge builds slowly, incrementally, and then medical practice adjusts. That’s why Dr. Donald Hensrud, preventive medicine specialist at the Mayo Clinic, says it makes no sense to turn around what we know about what makes us healthy every few years. Reflecting on the diet fads of the last decades, from high-protein, to low-fat, and locavore, he added: “Diet should be evolutionary, not revolutionary.”

Indeed, Dr. Junger wouldn’t be the first to build a health brand based on weak science or worse. One of his key competitors in the gluten-free camp is Wheat Belly mastermind Dr. William Davis, who has fingered the ancient grain as the source of all dieting evil. Like the many food faddists before him, Dr. Davis holds up his patients’ success stories as evidence his diet works, and says he doesn’t want to wait for the science to catch up. But as this academic analysis points out, while the diet may work in the short term for some, it’s probably because it forces calorie reduction not because of cutting wheat. As well, there’s little chance dieters will be able to stick to the demanding program.

Both Junger and Davis are physicians who would know you shouldn’t rely on anecdotes—no matter how awesome—to form the basis of clinical decisions, which should remind us of something else we do know from science: human beings are irrational, with a real incapacity to see reality when we have conflicts of interest like a health empire at stake.

Tests and time might yet reveal Dr. Junger’s cleansing systems, elimination diets and leaky-gut remedies to be the panaceas he promises. At that point, like any medicine that works, it should be added to the armamentarium. Until then, miracles based on anecdote must be considered science-ish, no matter how scientific they sound.

*Update: Dr. Junger’s CEO reported they are in talks with teaching hospitals to study the Clean program.

Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health ForumJulia Belluz is the senior editor at the Medical Post. Got a tip? Message julia.belluz@medicalpost.rogers.com or@juliaoftoronto on Twitter

 




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Second opinion: Talking detox with Gwyneth Paltrow’s doctor

  1. It is a little scary that evidence-based medicine is a relatively recent (Canadian) innovation, and is apparently nowhere near universally accepted.

    • Again, same thing. If I read this article I would think that Dr. Junger and his team were crazy.

      Its awesome what a little spin can do.

      Dhru, Clean CEO

  2. Excellent article. I don’t often hear celebrity alt-med proponents being so open about their disdain for science and evidence.

    • If I read this article, I would walk away with the same conclusion. And yet that’s not at all where we are coming from.

      The quote from Dr. Junger that says ”Spend a few days,” he said. “I’ll get you cured of the evidence-based medicine disease.”

      Was based on the idea that NOT everything that is published is true.

      Dhru

    • I agree. And many celebrity don’t usually share this kinds of things because they just want to keep it to themselves. It’s good the Dr. Junger has been open about his open medicine to public.

      __________________________
      electronic medical records

  3. “The fact is that organisms are never perfectly suited to their environment,” says evolutionary biologist Marlene Zuk, “the way evolution works is through a whole series of compromises and jerry-rigged solutions based on what was there before.”

    Zuk sat down with ReasonTV’s Tracy Oppenheimer to discuss her findings in her new book, Paleofantasy: What Evolution Really Tells Us about Sex, Diet, and How We Live. She says that the paleo diet, philosophy and lifestyle overlook “a lot of really cool stuff that’s been happening in evolution.”

    http://reason.com/reasontv/2013/04/22/debunking-the-caveman-craze-paleofantasy

  4. Julia, well written article, but with a certain lack of understanding of some of the things I said. When I told you about getting cured of the ‘science based medicine” disease, I did not mean that the disease IS science based medicine. The diseases is ONLY looking for answers there, because of the mistakes and corruption in many of these studies, and the fact that many things don’t get studied at all. But I get it, how could you really understand what I mean in a brief phone conversation ?
    Warm regards to you

    Alejandro Junger

    • Dr. Junger, thanks for this. I hope we can continue to debate about what makes good evidence and fair tests. It’s an interesting area and I will look forward to any trials you run on the Clean program. Best, Julia

  5. Julia asked me (Clean CEO) if we do follow up studies with our patients.

    I told her we don’t have the resources to do full blown studies but that we are in communication with two teaching hospitals to do clinical trials on the Clean Program.

    But that doesn’t mean that the work that we are doing isn’t based on research.

    All of our protocols come from the Institute for Functional Medicine. They are based on science, research, and the clinical experience of thousands of MDs across the world.

    But Julia did not mention that in the article even though it was mentioned on our call.

    It makes it seem as if the protocols we use came out of thin air.

    Dhru Purohit
    Clean CEO

    • Dhru, I think you forgot to add your medical credentials to your name. It might make you appear more…credible with your defence.

      • Hi Natural, no medical references. I’m the CEO. You know, like hospitals have a CEO as do research centers.

        Dr Junger is the MD and cardiologist.

        • Yeah, I get that Dhru, you have no credentials concerning the “science” of the Clean Program.

          If it wasn’t all wrapped up in a panacea bucket it would be easier to swallow. I wonder how much fresh vegetables and fruit a person can buy with $425 and then a minimum of $120 per month…my guess is they would feel pretty damn good on that regiment.

        • Are there many legitimate hospitals and research centers that don’t have a credentialed CEO? They’re generally MDs, sometimes PhDs.

          They’re also generally non-profit.

          On the other hand, marketing flacks are a dime a dozen.

    • Hey Dhru, Thanks for this note. I didn’t mention the possibility of trials because you said it wasn’t a primary focus, the plan was uncertain, and the mention of trials only came in response to my question after a long discussion of patient anecdotes as the primary evidence that the program works, and the patient examples speaking for themselves. Still, I have added this in an update and regret any an error of omission. Best, Julia

  6. Here’s the problem – an awful lot of what we call “medical science” isn’t subjected to scientific rigor, and might also fall under what Feynman would call “Cargo Cult Science.” http://neurotheory.columbia.edu/~ken/cargo_cult.html

    While I don’t equate the snake oil described here with medical research, nor think we should toss scientific inquiry into medicine, I do think we should put as much or more of our energy towards improving mainstream medical research. The wish to improve research should not, however, be confused with endorsing unproven medical practices.

    Step one would be the All Trials petition: http://www.alltrials.net/

  7. Unfortunately, my comments were cut and p

  8. Unfortunately, my comments in the article were cut and pasted out of context. Randomized controlled trials of “alternative therapies” prove that none of them cure cancer. To rely on them, to the exclusion of standard anti-cancer therapies, can decrease both survival and quality of life. However, rct’s have also shown that a small number of specific interventions, such as acupuncture for particular indications (e.g. emesis and pain) can provide benefit for the control of symptoms, particularly adverse effects from the medical treatments. These complementary therapies are clearly stated in evidence-based practice guidelines accessible to practitioners. Alternative therapies, such as 714X, Essiac, Laetrile, and Iscador (mistletoe), are propagated urban myths and fads without scientific proof at the clinical level. In addition, the early extrapolation of laboratory data to the clinic without testing in randomized controlled trials can be both detrimental to the patient as well as destroying future knowledge. It is a tragedy that bogus and clinically untested therapies, often showcased through celebrity pseudo-doctors, and the early adoption of (potentially unsafe) novelty treatments benefit no one else but the financially-orientated practitioner and the ego of the celebrity.

  9. It’s a shame that quacks & charlatans like dhrumil & junger exist and pray on people. I’d say junger was the direct cause of gwyneth’s osteopenia. At points, she wasn’t even able to lift her old children due to these rapists of humanity.

  10. And yet, the medical (and scientific) community ridiculed the concept of essential oils, because it hadn’t been discovered and tested by them. (Anybody remember the movie, “Lorenzo’s Oil?”) Modern medicine is excellent-to-outstanding at trauma and surgery, and sorely lacking at daily maintenance. (Read the “recommended daily intake” for many vitamins and minerals — often they’re a fraction of what the body really needs! For example, we’re cautioned about not overdosing on Vitamin D, for example, but did you know you have to take in excess of 40,000 IU/lday to overdose?) Am I suggesting that we ignore doctors and modern medicine? Absolutely not! BUT, we must also not take modern medicine as gospel and infallible. There’s much more knowledge out there, even if “modern science” doesn’t admit it, or even scoffs. Each individual is responsible for doing his/her own investigation into his/her own body to learn how it works best, or to find out how to overcome whichever weaknesses and ailments.

  11. The “skeptic” notion that real-world results are not “evidence” is quite the exercise in philosophical gymnastics. This isn’t science. It’s not even common sense.
    The bias of this article is evident at the start and it doesn’t get much better.
    Cutting calories eliminates more muscle tissue than fat, and it’s well established that when the dieter eventually consumes more calories s/he ends up with a higher percentage of body fat than ever. All calories are not equal — this is the false mantra of the manufactured food industry.
    Mainstream medicine has nothing to do with lifestyle/fitness/nutrition — it’s a system designed to treat the symptoms of disease with either drugs or surgery. It’s not health care, it’s sick care.
    There may be no test for “leaky gut” but there certainly are identifiable signs and symptoms that an experienced clinician can recognize.

  12. Ah, continuing the fine tradition of peddling placebo. It never gets old.

  13. I would suggest everyone to get a second opinion just to be safe. I have
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